New Patient Form

Please be assured that this information is maintained in accordance with State and Federal Privacy Legislation. If you would like any further information about how we use and protect your personal information, please ask one of our staff for our “Personal Information, Privacy and your Dentist” document. Click here for our privacy policy.

Your medical and dental history

As a new patient at Katanning Dental Centre, we will ask that you fill in a Medical and Dental Health form before your first visit. For your convenience we have made this form available online so you can print it in advance and email/fax it in or bring it into our practice for your first appointment.

All the information is held in strict confidence and will be used to assist in your dental assessment and treatment planning.

Please visit this page on desktop to fill up the form.